Mont. Admin. r. 37.83.501

Current through Register Vol. 23, December 6, 2024

Rule 37.83.501 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES, APPLICATION AND ELIGIBILITY FOR MEDICAID

(1) A person is a specified low income medicare beneficiary eligible for medicaid as provided in (7) of this rule if the person:

(a) is entitled to medicare Part A benefits as provided in 42 USC 1395 c et seq.;

(b) meets the nonfinancial criteria in (3) of this rule;

(c) has countable resources not in excess of two times the resource limitation applicable to the federal supplemental security income (SSI) resource limitation at 42 USC 1382 a; and

(d) has countable income as determined in accordance with this section;

(i) countable income may not be less than 100% of the federal poverty income standard nor more than:

(A) 110% of the federal poverty income standard for calendar year 1993; and

(B) 120% of the federal poverty income standard beginning January 1, 1994.

(2) When determining countable income, cost of living increases to the client's Title II social security benefits shall be excluded from December of each year through the month after the official federal poverty standards are published.

(3) The non-financial criteria for determining eligibility of a medicaid specified low income medicare beneficiary are that the person:

(a) is categorically eligible under the federal Social Security Act as being:

(i) age 65 or older;

(ii) blind; or

(iii) disabled;

(b) has a social security number;

(c) meets the citizenship or alienage requirements of ARM 37.82.401; and

(d) meets the residency requirements of ARM 37.82.402.

(4) A person in applying for and receiving medicaid as a specified low income medicare beneficiary is subject to the following provisions:

(a) ARM 37.82.201 concerning application requirements;

(b) ARM 37.82.204 concerning determinations of eligibility;

(c) ARM 37.82.205 concerning redetermination of eligibility; and

(d) ARM 37.82.407 concerning limitation on the financial responsibility of relatives.

(5) Countable income and resources will be determined using SSI criteria incorporated by reference in ARM 37.82.903(2).

(6) A person receiving medicaid as a specified low income medicare beneficiary must report within 10 days any changes in circumstances that may affect eligibility.

(7) Medicaid coverage for a person eligible for medicaid only as a specified low income beneficiary shall be limited to payment of medicare Part B premiums.

(8) A specified low income medicare beneficiary may be eligible for retroactive coverage for any or all of the 3 months immediately preceding the month of application, if the applicant met all of the financial and non-financial criteria set forth in (1) (a) through (5) of this rule in that month.

Mont. Admin. r. 37.83.501

NEW, 1993 MAR p. 1542, Eff. 7/16/93; TRANS, from SRS, 2000 MAR p. 197.

Sec. 53-2-201, 53-6-111 and 53-6-113, MCA; IMP, Sec. 53-6-101 and 53-6-131, MCA;